Download PDF
Thromb Haemost 2006; 96(04): 478-482
DOI: 10.1160/TH06-07-0416
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Prognostic value of D-dimer in patients with pulmonary embolism

Drahomir Aujesky
1   Division of Internal Medicine, University of Lausanne, Lausanne, Switzerland
,
Pierre-Marie Roy
2   Department of Emergency Medicine, University of Angers, Angers, France
,
Meyer Guy
3   Department of Respiratory and Critical Care Medicine, Hôpital Européen Georges Pompidou, Paris, France
,
Jacques Cornuz
1   Division of Internal Medicine, University of Lausanne, Lausanne, Switzerland
4   University Outpatient Clinic, University of Lausanne, Lausanne, Switzerland
,
Olivier Sanchez
3   Department of Respiratory and Critical Care Medicine, Hôpital Européen Georges Pompidou, Paris, France
,
Arnaud Perrier
5   Division of General Internal Medicine, University of Geneva, Geneva, Switzerland
› Author Affiliations
Further Information

Publication History

Received 30 July 2006

Accepted after revision 31 August 2006

Publication Date:
29 November 2017 (online)

    Permissions and Reprints

Summary

D-dimer levels appear to be associated with the extent of the thromboembolic burden in patients with pulmonary embolism (PE).We therefore hypothesized that D-dimer levels at admission would be associated with prospective risk of mortality in patients with PE. We used data from 366 patients diagnosed with PE at four hospital emergency departments. A highly sensitive D-dimer test was prospectively performed at admission. The outcome was overall mortality within three months. We divided patients into quartiles on the basis of their D-dimer levels and compared mortality rates by quartile. We estimated sensitivity, specificity, and predictive values for mortality in the first and fourth quartile. Overall mortality was 5.2%. Patients who died had higher median D-dimer levels than patients who survived (4578 versus 2946 µg/l; P=0.005). Mortality increased with increasing D-dimer levels, rising from 1.1% in the first quartile (<1500 µg/l) to 9.1% in the fourth quartile (>5500 µg/l) (P=0.049). Sensitivity, specificity, and positive and negative predictive values of D-dimer levels <1500 µg/l to predict mortality were 95%, 26%, 7%, and 99%, respectively. Patients with PE who have D-dimer levels below 1500 µg/l havea very low mortality. Further studies must assess whether D-dimer, alone or combined with other prognostic instruments for PE, can be used to identify low-risk patients with PE who are potential candidates for outpatient treatment or an abbreviated hospital stay.

Keywords

D-dimer - pulmonary embolism - prognosis
 

  • References

  • 1 Aujesky D, Obrosky DS, Stone RA. et al. Derivation and validation of a prognostic model for pulmonary embolism. Am J Resp Crit Care Med 2005; 172: 1041-6.
    CrossrefPubMedGoogle Scholar
  • 2 Aujesky D, Roy PM, Le Manach CP. et al. Validation of a model to predict adverse outcomes in patients with pulmonary embolism. Eur HeartJ 2006; 27: 476-81.
    PubMedGoogle Scholar
  • 3 Konstantinides S, Geibel A, Olschewski M. et al. Importance of cardiac troponins I and T in risk stratification of patients with acute pulmonary embolism. Circulation 2002; 106: 1263-8.
    CrossrefPubMedGoogle Scholar
  • 4 ten Wolde M, Tulevski II, Mulder JW. et al. Brain natriuretic peptide as a predictor of adverse outcome in patients with pulmonary embolism. Circulation 2003; 107: 2082-4.
    CrossrefPubMedGoogle Scholar
  • 5 ten Wolde M, Sohne M, Quak E. et al. Prognostic value of echocardiographically assessed right ventricular dysfunction in patients with pulmonary embolism. Arch Intern Med 2004; 164: 1685-9.
    CrossrefPubMedGoogle Scholar
  • 6 Schoepf UJ, Kucher N, Kipfmueller F. et al. Right ventricular enlargement on chest computed tomography: a predictor of early death in acute pulmonary embolism. Circulation 2004; 110: 3276-80.
    CrossrefPubMedGoogle Scholar
  • 7 van der Meer RW, Pattynama PM, van Strijen MJ. et al. Right ventricular dysfunction and pulmonary obstruction index at helical CT: prediction of clinical outcome during 3-month follow-up in patients with acute pulmonary embolism. Radiology 2005; 235: 798-803.
    CrossrefPubMedGoogle Scholar
  • 8 Alehagen U, Dahlstrom U, Lindahl TL. Elevated D-dimer level is an independent risk factor for cardiovascular death in out-patients with symptoms compatible with heart failure. Thromb Haemost 2004; 92: 1250-8.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Marcucci R, Gori AM, Giannotti F. et al. Markers of hypercoagulability and inflammation predict mortality in patients with heart failure. J Thromb Haemost 2006; 04: 1017-22.
    CrossrefPubMedGoogle Scholar
  • 10 Fiotti N, Di Chiara A, Altamura N. et al. Coagulation indicators in chronic stable effort angina and unstable angina: relationship with acute phase reactants and clinical outcome. Blood Coagul Fibrinolysis 2002; 13: 247-55.
    CrossrefPubMedGoogle Scholar
  • 11 Mahe I, Drouet L, Simoneau G. et al. D-dimer can predict survival in patients with chronic atrial fibrillation. Blood Coagul Fibrinolysis 2004; 15: 413-7.
    CrossrefPubMedGoogle Scholar
  • 12 Querol-Ribelles JM, Tenias JM, Grau E. et al. Plasma d-dimer levels correlate with outcomes in patients with community-acquired pneumonia. Chest 2004; 126: 1087-92.
    CrossrefPubMedGoogle Scholar
  • 13 Ferrigno D, Buccheri G, Ricca I. Prognostic significance of blood coagulation tests in lung cancer. Eur Respir J 2001; 17: 667-73.
    CrossrefPubMedGoogle Scholar
  • 14 Galle C, Papazyan JP, Miron MJ. et al. Prediction of pulmonary embolism extent by clinical findings, D-dimer level and deep vein thrombosis shown by ultrasound. Thromb Haemost 2001; 86: 1156-60.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Perrier A, Howarth N, Didier D. et al. Performance of helical computed tomography in unselected outpatients with suspected pulmonary embolism. Ann Intern Med 2001; 135: 88-97.
    CrossrefPubMedGoogle Scholar
  • 16 Perrier A, Roy PM, Aujesky D. et al. Diagnosing pulmonary embolism in outpatients with clinical assessment, D-dimer measurement, venous ultrasound, and helical computed tomography: a multicenter management study. AmJ Med 2004; 116: 291-9.
    CrossrefPubMedGoogle Scholar
  • 17 Perrier A, Roy PM, Sanchez O. et al. Multidetectorrow computed tomography in suspected pulmonary embolism. N Engl J Med 2005; 352: 1760-8.
    CrossrefPubMedGoogle Scholar
  • 18 Sohne M, Ten Wolde M, Buller HR. Biomarkers in pulmonary embolism. Curr Opin Cardiol 2004; 19: 558-62.
    CrossrefPubMedGoogle Scholar
  • 19 Quiroz R, Kucher N, Schoepf UJ. et al. Right ventricular enlargement on chest computed tomography: prognostic role in acute pulmonary embolism. Circulation 2004; 109: 2401-4.
    CrossrefPubMedGoogle Scholar
  • 20 Wells PS, Kovacs MJ, Bormanis J. et al. Expanding eligibility for outpatient treatment of deep venous thrombosis and pulmonary embolism with low-molecular-weight heparin: a comparison of patient self-injection with homecare injection. Arch Intern Med 1998; 158: 1809-12.
    CrossrefPubMedGoogle Scholar
  • 21 Kovacs MJ, Anderson D, Morrow B. et al. Outpatient treatment of pulmonary embolism with dalteparin. Thromb Haemost 2000; 83: 209-11.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Wells PS, Anderson DR, Rodger MA. et al. A randomized trial comparing 2 low-molecular-weight heparins for the outpatient treatment of deep vein thrombosis and pulmonary embolism. Arch Intern Med 2005; 165: 733-8.
    CrossrefPubMedGoogle Scholar
  • 23 Aujesky D, Smith KJ, Cornuz J. et al. Cost-effectiveness of low-molecular-weight heparin for treatment of pulmonary embolism. Chest 2005; 128: 1601-10.
    CrossrefPubMedGoogle Scholar
  • 24 Gibson NS, Sohne M, Buller HR. Prognostic value of echocardiography and spiral computed tomography in patients with pulmonary embolism. Curr Opin Pulm Med 2005; 11: 380-4.
    PubMedGoogle Scholar
  • 25 Masotti L, Ceccarelli E, Cappelli R. et al. Plasma D-dimer levels in elderly patients with suspected pulmonary embolism. Thromb Res 2000; 98: 577-9.
    CrossrefPubMedGoogle Scholar
  • 26 Righini M, Le Gal G, De Lucia S. et al. Clinical usefulness of D-dimer testing in cancer patients with suspected pulmonary embolism. Thromb Haemost 2006; 95: 715-9.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Walston J, McBurnie MA, Newman A. et al. Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study. Arch Intern Med 2002; 162: 2333-41.
    CrossrefPubMedGoogle Scholar
  • 28 Stein PD, Hull RD, Patel KC. et al. D-dimer for the exclusion of acute venous thrombosis and pulmonary embolism: a systematic review. Ann Intern Med 2004; 140: 589-602.
    CrossrefPubMedGoogle Scholar